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Year 3 - Junior Surgery > Varicose veins and Ulcers > Flashcards

Varicose veins and Ulcers Flashcards

1
Q

What are varicose veins?

A

Tortuous, dilated veins

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2
Q

What is the pathology of varicose veins?

A

Incompetent valves lead to back flow of venous blood leading pooling to venous hypertension causing dilation ov the vessels

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3
Q

What is the aetiology of varicose veins?

A

Mostly idiopathic

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4
Q

What are the four major risk factors for varicose veins?

A
  • Prolonged standing
  • Obesity
  • Pregnancy
  • Family history
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5
Q

How are varicose veins confirmed?

A

Duplex ultrasound

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6
Q

How do varicose veins present?

A
  • Visibly dilated tortuous veins
  • Varicosities over the courses of the great and small saphenous veins
  • Can be painful, itchy and swollen
  • Can show symptoms of venous insufficiency
  • Can have saphena varix
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7
Q

What are some symptoms ov venous insufficiency?

A
  • Oedema
  • Thrombophlebitis
  • Ulcers
  • Lipodermatosclerosis
  • Atrophie Blanche
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8
Q

What is saphena varix?

A

A varicose vein in the groin with a cough reflex

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9
Q

In what ways can varicose veins be managed?

A
  • Surgically
  • Non-surgically
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10
Q

When is surgical management used for varicose veins?

A

In non-cosmetic cases where the problem is due to symptomatic skin changes or ulceration

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11
Q

How are varicose veins managed non-surgically?

A
  • Patient education
  • Compression stockings
  • 4 layer bandaging for venous ulceration
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12
Q

How can patients with varicose veins be educated to improve their condition?

A

Promote less standing and more walking

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13
Q

How can varicose veins be managed surgically?

A
  • Vein ligation, stripping and avulsion
  • Foam sclerotherapy
  • Thermal ablation
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14
Q

What happens to varicose veins over time?

A

They will get progressively worse

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15
Q

What does worsening of varicose veins over time carry increased risk of?

A
  • Thrombophlebitis
  • Ulceration
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16
Q

What are the three main types of skin ulcers?

A
  • Venous
  • Neuropathic
  • Arterial
17
Q

Which type of skin ulcers are most common?

A

Venous ulcers

18
Q

How do venous ulcers appear?

A

Shallow with a granulated base

19
Q

What causes venous ulcers?

A

Venous insufficiency due to incompetent valves leading to pooling of blood and impaired gas exchange

20
Q

How do venous ulcers present?

A
  • Painful
  • Worse at the end of the day
  • Dry and itchy surrounding skin
  • Often have varicose veins and associated symptoms
21
Q

How are venous ulcers investigated?

A
  • Duplex ultrasound
  • Normal ABPI results
22
Q

How are venous ulcers managed?

A
  • Compression bandages (must exclude arterial insufficiency)
  • Improve flow by less standing and more walking
23
Q

Where are venous ulcers most common?

A

Gaiter area of the leg (lower shin and ankles)

24
Q

When do neuropathic ulcers occur?

A

Damaged skin left unnoticed due to neuropathy caused by DM/B12 deficiency

25
Q

How can neuropathic ulcers be investigated?

A
  • Test HbA1c/blood glucose
  • Test serum B12
  • X-ray to exclude osteomyelitis
  • ABPI
  • Duplex ultrasound to rule out venous ulcer
26
Q

What does an ABPI <0.8 in a neuropahtic ulcer suggest?

A

Neuroischaemic ulcer

27
Q

How are neuropathic ulcers managed?

A
  • Manage diet for B12/diabetes
  • Refer to foot clinic/chiropodist
  • Improve control of DM
  • Treat infections
28
Q

Where do neuropathic ulcers appear?

A

On bony areas that undergo pressure

29
Q

How do neuropathic ulcers present?

A
  • Painless
  • Punched out defined ulcer often on the foot
    *
30
Q

What causes arterial ulcers?

A

Arterial insufficiency

31
Q

How may arterial ulcers present?

A
  • Possible history of intermittent claudication or critical limb ischaemia
  • Cold/pulseless limbs
  • Slow developing ulcer with defined edges
32
Q

How can arterial ulcers be investigated?

A
  • ABPI
  • CT
  • Duplex ultrasound
33
Q

How are arterial ulcers managed?

A
  • Lifestyle modification
  • Risk factor modification using medication
  • Surgery
34
Q

What surgery can be used for arterial ulcers?

A
  • PCI
  • Arterial bypass
35
Q
A

Year 3 - Junior Surgery (12 decks)

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